Cryptococcus tetragattii Meningitis Associated with Travel, Taiwan

Meningitis caused by Cryptococcus tetragattii fungus is rare and has been found in specific geographic regions. We report a case of meningitis caused by C. tetragattii (molecular type VGIV) in an immunocompetent patient in Taiwan. The patient had traveled to Egypt and was positive for granulocyte-macrophage colony-stimulating factor autoantibody.

Induction treatment for the cryptococcal meningitis involved liposomal amphotericin B (200 mg/d) plus oral flucytosine (1,250 mg/6 h) for 21 days. A follow-up CSF culture revealed negative growth on hospital day 15. Oral voriconazole (250 mg/12 h) was prescribed as consolidation treatment for 15 days. The patient was discharged in stable condition and followed up at the outpatient department. She received oral fluconazole (400 mg/d) for the subsequent 6 months and remained well.
In this case, the patient is an immunocompetent host who had previously received 1 dose of the ChAdOx1-S vaccine and had a travel history to Egypt 2 years before symptom onset of meningitis. The members of the C. gattii species complex has different geographic distribution, and C. tetragattii is mostly isolated in Africa (5). Approximately 20% of the HIV-infected tested population had cryptococcal meningitis caused by C. tetragattii in Zimbabwe (6). In addition, anti-GM-CSF AAb has been detected in immunocompetent patients with C. gattii infection, as well as those with C. neoformans infection (4).
Whether COVID-19 vaccines have a trigger effect in unmasking underlying diseases, such as that in our

RESEARCH LETTERS
Meningitis caused by Cryptococcus tetragattii fungus is rare and has been found in specific geographic regions.
We report a case of meningitis caused by C. tetragattii (molecular type VGIV) in an immunocompetent patient in Taiwan. The patient had traveled to Egypt and was positive for granulocyte-macrophage colony-stimulating factor autoantibody.
patient, warrants further study. To our knowledge, no studies demonstrate the relationship between anti-GM-CSF AAb and COVID-19 vaccines. However, research showed that autoantibody such as anti-smooth muscle antibody was triggered by COVID-19 vaccine as autoimmune hepatitis (7). In conclusion, clinicians should be aware of possible C. tetragattii fungal infection in patients who have traveled to meningitisendemic regions.

M onkeypox virus (MPXV) is a zoonotic pathogen
that causes mpox (formerly monkeypox), a febrile rash disease, in humans. It has caused multiple outbreaks in the past (1) but recently acquired international attention because of a multicountry outbreak of mpox cases with no epidemiologic link to MPXVendemic regions (2). During January-June 2022, a total of 3,413 laboratory-confirmed cases and 1 death were reported to the World Health Organization (3).
MPXV is a double-stranded DNA virus that belongs to the genus Orthopoxvirus within the Poxviridae family. A total of 3 clades have been proposed: clades 1, 2, and 3 (4). Genomes belonging to the recent outbreaks gather at clade 3 and create the human MPXV1 subclade.

RESEARCH LETTERS
Monkeypox virus (MPXV) has gained interest because of a multicountry outbreak of mpox (formerly monkeypox) cases with no epidemiologic link to MPXV-endemic regions. We sequenced the complete genome of MPXV isolated from a patient in northern Mexico. Phylogenetic analysis grouped the virus with isolates from Germany.